Homestead_Falls (4) 1 H. PREPARER
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1 Preparer of the ales Disclossare Form 1 Trite 11-1 44 0'j1ii, sei `• h-es1/4 : Settlement Agent
l Company J E-mail address
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Address(number and street crty slate country. and ZIP Code)
20 NW 1st Street,Suite 100,Evansville,IN 47708
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1. SELLER(S)/GRANTOR(S)
Seller 1 •Name as it appears on conveyance document Seller 2 - Name as appears on convplif nitef:D
Adam G.Chitwood Alicia J.Chitwood
Address(number and street) Address(number and street)
4aa-s-etbsef-St.-- 5 (( S.- TA-ck soil . 438.-&-Gee-.S4---- S--- 4--4/\NZ 0 2 2022
IC '
City.slate and ZIP Code ' City slate,and ZIP Code
Oakland City,IN 47660 . Oakland City,IN 47660
a lik Country . Country
I1226cGIBSDA"COUNTY_OUNTYAdj'Ut1 T407
. US US
4.)
the best of my knowledge and belief.is true,correct and complete as
i required by law,and Is prepared in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
i real property,or omits or falsifies any information required to be provided,commits a Level 5 felony.
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Signatur,of Seller / f,
---7-7 .7 Signatu '5eller / ,
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'Printed Name of Se:let Date signed(rnmiddyyyy) Rot! e Name of Seller Date signed(mmlddiyyyy)
. Adam G.Chitwood 07/18/2022 Alicia J.Chitwood 07/18/2022
J. BUYER(S) GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS—IDENTIFY ALL THAT APPLY
Buyer 1 Name as it appears on conveyance document Buyer 2 Name as it appears on conveyance document
Brenda Falls Darrell Falls
Address(number and street) Address(number arid street)
4-r3 Z. 5 C /t_. € k . SAME
City.stale and ZI Code j City state and ZIP Code
' a V<ck, cA ,-) . N 1-r7Q-6 0
Country Country
US ' US
E-mail address
for certain deductions.Identify all of those that apply:
1-- YES NO CONDITION YES NO CONDITION
0.
0 . m.,
. i.a.i 0 1.Will this property be the buyer's primary CV 0 3. Homestead
residence? 0 12 4.Solar Energy Heating or Cooling System
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...T'
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0 5.Wind Power Device
2.Does the buyer
. ()1( have a homestead to be vacated
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0 for this residence? If yes.provide address: 0 dr) 6.Hydroelectric Power Device
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c) Address(number,and stteolL.-11. 650 k-.
l, 0 (3i 7.Geothermal Energy Heating or Cooling Device
A
q0 • city:,state. lPt code.an+ceunty
44,k_ - r4, r7 Oki,°I -_ LA -4- L N i:-"-M Wall ,__C ,iti-1 c(--z-0(-o oo, 6 cz, -0 04
Under penalties of perjury.I h reby certify that this Sales..Asclosure,to the best of my knowledge and belief.Is true,correct and complete
1 . as required by law,and is pre aired in accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of
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